Hospital

BARRETT HOSPITAL & HEALTHCARE

Dillon, MT · CCN 271318 · Rates published

Your selected procedure

You selected 93350 (HCPCS)

Ultrasound of heart during rest, exercise and/or drug-induced stress with report

This hospital’s price: $1,313 across 15 payers · range $113-$1,459

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbBarrettHospital&type=CDMWithoutLabel&fileType=CSV · observed 2026-05-13

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

6,472 distinct procedures filed

15 distinct payers

96,440 rate rows

2026-05-13 last MRF observed

Data quality

94,380 of 96,440 rate rows are consumer-grade (97.9%)

2,060 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	1,066
percent-of-charges filed in the dollar field — excluded from medians	707
per-diem day rate — not a per-procedure price	184
template filing: same amount across many unrelated codes — excluded	90
exceeds 10× this hospital's gross charge — excluded from medians	13

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbBarrettHospital&type=CDMWithoutLabel&fileType=CSV
Found on page	https://apps.para-hcfs.com/PTT/FinalLinks/Barrett_V2.aspx
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-26
Content fingerprint	dec30eb98dd91721… · 36,643,330 bytes · first seen 2026-05-14

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
1216502_1 CDM	Advanced Locking Screw 5x95mm	3	$3,356,577.00	$4,699,207.80	$3,412,519.95	nat. median $3,412,520 1.0× median
J2350 HCPCS	Injection, Ocrelizumab, 1 Mg	15	$206.59	$51,927.73	$49,331.34	nat. median $470 outlier · 105.0×
J3241 HCPCS	Injection, Teprotumumab-trbw, 10 Mg	15	$26,868.84	$44,781.40	$42,542.33	nat. median $729 outlier · 58.3×
J9022 HCPCS	Injection, Atezolizumab, 10 Mg	15	$274.80	$42,159.88	$40,051.89	nat. median $6,785 outlier · 5.9×
J2327 HCPCS	Injection, Risankizumab-rzaa, Intravenous, 1 Mg	15	$16,500.98	$27,501.63	$26,126.55	nat. median $2,076 outlier · 12.6×
J9043 HCPCS	Injection, Cabazitaxel, 1 Mg	15	$650.29	$25,396.60	$24,126.77	nat. median $735 outlier · 32.8×
J9271 HCPCS	Injection, Pembrolizumab, 1 Mg	15	$170.66	$21,671.45	$20,587.88	nat. median $276 outlier · 74.7×
J9144 HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	15	$11,575.28	$19,292.14	$18,327.53	nat. median $211 outlier · 86.7×
J9011 HCPCS	Injection, Datopotamab Deruxtecan-dlnk, 1 Mg	15	$10,571.71	$17,619.51	$16,738.53	nat. median $250 outlier · 67.0×
J3380 HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	15	$73.43	$17,440.85	$16,568.81	nat. median $162 outlier · 102.3×
J9173 HCPCS	Injection, Durvalumab, 10 Mg	15	$274.80	$15,547.32	$14,769.95	nat. median $1,119 outlier · 13.2×
J0565 HCPCS	Injection, Bezlotoxumab, 10 Mg	15	$146.78	$13,420.90	$12,749.86	nat. median $159 outlier · 80.0×
J2323 HCPCS	Injection, Natalizumab, 1 Mg	15	$74.18	$12,942.55	$12,295.42	nat. median $197 outlier · 62.3×
J1306 HCPCS	Injection, Inclisiran, 1 Mg	15	$7,392.97	$12,321.62	$11,705.54	nat. median $44 outlier · 265.1×
J9299 HCPCS	Injection, Nivolumab, 1 Mg	15	$100.01	$28,614.86	$11,684.33	nat. median $2,889 outlier · 4.0×
J1930 HCPCS	Injection, Lanreotide, 1 Mg	15	$209.59	$17,156.69	$10,706.29	nat. median $5,088 outlier · 2.1×
36010226_1 CDM	Operating Room Services - General Classification	15	$6,295.20	$10,492.00	$9,967.40	nat. median $9,443 1.1× median
J9332 HCPCS	Injection, Efgartigimod Alfa-fcab, 2mg	15	$6,282.62	$10,471.04	$9,947.49	nat. median $112 outlier · 88.5×
Q5123 HCPCS	Injection, Rituximab-arrx, Biosimilar, (riabni), 10 Mg	15	$5,599.04	$9,331.73	$8,865.14	nat. median $1,006 outlier · 8.8×
J1162 HCPCS	Injection, Digoxin Immune Fab (ovine), Per Vial	15	$5,208.53	$13,711.88	$8,246.84	nat. median $7,141 1.2× median
36010224_1 CDM	Operating Room Services - General Classification	15	$4,948.80	$8,248.00	$7,835.60	nat. median $7,423 1.1× median
J9312 HCPCS	Injection, Rituximab, 10 Mg	15	$349.84	$8,104.89	$7,699.65	nat. median $1,071 outlier · 7.2×
J3247 HCPCS	Injection, Secukinumab, Intravenous, 1 Mg	15	$4,673.47	$7,789.11	$7,399.65	nat. median $49 outlier · 150.1×
1144703_1 CDM	Bigopsy Backloading Forceps	15	$4,667.69	$7,779.48	$7,390.51	nat. median $7,391 1.0× median
148511_ERX_1 CDM	Varithena Injectable Foam	15	$4,645.20	$7,742.00	$7,354.90	nat. median $7,355 1.0× median
J9177 HCPCS	Injection, Enfortumab Vedotin-ejfv, 0.25 Mg	15	$4,361.81	$7,269.68	$6,906.20	nat. median $2,933 outlier · 2.4×
J2353 HCPCS	Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg	15	$749.36	$7,266.09	$6,902.79	nat. median $5,573 1.2× median
27650 HCPCS	Repair Of Ruptured Achilles Tendon	15	$239.20	$7,358.00	$6,622.20	nat. median $6,674 1.0× median
36010222_1 CDM	Operating Room Services - General Classification	15	$4,152.00	$6,920.00	$6,574.00	nat. median $6,228 1.1× median
J9061 HCPCS	Injection, Amivantamab-vmjw, 2 Mg	15	$4,118.00	$6,863.33	$6,520.16	nat. median $68 outlier · 96.2×
J2506 HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	15	$4,101.96	$6,836.60	$6,494.77	nat. median $1,646 outlier · 3.9×
J1602 HCPCS	Injection, Golimumab, 1 Mg, For Intravenous Use	15	$126.38	$6,503.37	$6,178.20	nat. median $273 outlier · 22.7×
J0897 HCPCS	Injection, Denosumab, 1 Mg	15	$69.64	$11,226.50	$6,101.84	nat. median $1,972 outlier · 3.1×
Q5111 HCPCS	Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg	15	$1,343.81	$11,062.47	$5,532.87	nat. median $1,982 outlier · 2.8×
36010220_1 CDM	Operating Room Services - General Classification	15	$3,448.20	$5,747.00	$5,459.65	nat. median $5,172 1.1× median
37191 HCPCS	Insertion Of Vena Cava Filter With Review By Radiologist	15	$3,410.40	$5,684.00	$5,399.80	nat. median $6,251 0.9× median
J3358 HCPCS	Ustekinumab, For Intravenous Injection, 1 Mg	15	$44.85	$5,386.18	$5,116.87	nat. median $326 outlier · 15.7×
J0129 HCPCS	Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…	15	$140.74	$5,221.25	$4,960.19	nat. median $902 outlier · 5.5×
1305396_1 CDM	3.0mm Fibulock Fibular Nail Right 180mm	15	$2,965.05	$4,941.75	$4,694.66	nat. median $4,695 1.0× median
1305378_1 CDM	3.0mm Fibulock Fibular Nail Right 130mm	15	$2,965.05	$4,941.75	$4,694.66	nat. median $4,695 1.0× median
1305402_1 CDM	3.0mm Fibulock Fibular Nail Left 130mm	15	$2,965.05	$4,941.75	$4,694.66	nat. median $4,695 1.0× median
1305405_1 CDM	3.0mm Fibulock Fibular Nail Left 180mm	15	$2,965.05	$4,941.75	$4,694.66	nat. median $4,695 1.0× median
J0717 HCPCS	Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm…	15	$37.16	$4,932.61	$4,685.98	nat. median $1,598 outlier · 2.9×
1045354_1 CDM	Ventralight With Echo2 20x25cm	15	$2,958.66	$4,931.10	$4,684.55	nat. median $4,685 1.0× median
156610_1 CDM	Pin To Rod Coupling Inverted	15	$2,934.60	$4,891.00	$4,646.45	nat. median $4,646 1.0× median
J3111 HCPCS	Injection, Romosozumab-aqqg, 1 Mg	15	$2,857.24	$4,762.07	$4,523.97	nat. median $681 outlier · 6.6×
36010218_1 CDM	Operating Room Services - General Classification	15	$2,840.40	$4,734.00	$4,497.30	nat. median $4,261 1.1× median
338895_1 CDM	Stem Cemented Advocate 13x130	15	$2,831.40	$4,719.00	$4,483.05	nat. median $4,483 1.0× median
338893_1 CDM	Stem Cemented Advocate 11x120 Standard	15	$2,831.40	$4,719.00	$4,483.05	nat. median $4,483 1.0× median
338894_1 CDM	Stem Cemented Advocate 12x125	15	$2,831.40	$4,719.00	$4,483.05	nat. median $4,483 1.0× median

Other procedures at this hospital

Browse this hospital's 6,472 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

1216502_1	CDM	Advanced Locking Screw 5x95mm	3	3	—	—	$3,356,577.00	$4,699,207.80	$3,412,519.95	2026-05-13
J2350	HCPCS	Injection, Ocrelizumab, 1 Mg	15	15	$51,927.73	$49,331.34	$206.59	$51,927.73	$49,331.34	2026-05-13
J3241	HCPCS	Injection, Teprotumumab-trbw, 10 Mg	15	15	$44,781.40	$42,542.33	$26,868.84	$44,781.40	$42,542.33	2026-05-13
J9022	HCPCS	Injection, Atezolizumab, 10 Mg	15	15	$42,159.88	$40,051.89	$274.80	$42,159.88	$40,051.89	2026-05-13
J2327	HCPCS	Injection, Risankizumab-rzaa, Intravenous, 1 Mg	15	15	$27,501.63	$26,126.55	$16,500.98	$27,501.63	$26,126.55	2026-05-13
J9043	HCPCS	Injection, Cabazitaxel, 1 Mg	15	15	$25,396.60	$24,126.77	$650.29	$25,396.60	$24,126.77	2026-05-13
J9271	HCPCS	Injection, Pembrolizumab, 1 Mg	15	15	$21,671.45	$20,587.88	$170.66	$21,671.45	$20,587.88	2026-05-13
J9144	HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	15	15	$19,292.14	$18,327.53	$11,575.28	$19,292.14	$18,327.53	2026-05-13
J9011	HCPCS	Injection, Datopotamab Deruxtecan-dlnk, 1 Mg	15	15	$17,619.51	$16,738.53	$10,571.71	$17,619.51	$16,738.53	2026-05-13
J3380	HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	15	15	$17,440.85	$16,568.81	$73.43	$17,440.85	$16,568.81	2026-05-13
J9173	HCPCS	Injection, Durvalumab, 10 Mg	15	15	$15,547.32	$14,769.95	$274.80	$15,547.32	$14,769.95	2026-05-13
J0565	HCPCS	Injection, Bezlotoxumab, 10 Mg	15	15	$13,420.90	$12,749.86	$146.78	$13,420.90	$12,749.86	2026-05-13
J2323	HCPCS	Injection, Natalizumab, 1 Mg	15	15	$12,942.55	$12,295.42	$74.18	$12,942.55	$12,295.42	2026-05-13
J1306	HCPCS	Injection, Inclisiran, 1 Mg	15	15	$12,321.62	$11,705.54	$7,392.97	$12,321.62	$11,705.54	2026-05-13
J9299	HCPCS	Injection, Nivolumab, 1 Mg	57	15	$11,922.79	$11,326.65	$100.01	$28,614.86	$11,684.33	2026-05-13
J1930	HCPCS	Injection, Lanreotide, 1 Mg	29	15	$17,156.69	$16,298.86	$209.59	$17,156.69	$10,706.29	2026-05-13
36010226_1	CDM	Operating Room Services - General Classification	15	15	$10,492.00	$9,967.40	$6,295.20	$10,492.00	$9,967.40	2026-05-13
J9332	HCPCS	Injection, Efgartigimod Alfa-fcab, 2mg	15	15	$10,471.04	$9,947.49	$6,282.62	$10,471.04	$9,947.49	2026-05-13
Q5123	HCPCS	Injection, Rituximab-arrx, Biosimilar, (riabni), 10 Mg	15	15	$9,331.73	$8,865.14	$5,599.04	$9,331.73	$8,865.14	2026-05-13
J1162	HCPCS	Injection, Digoxin Immune Fab (ovine), Per Vial	15	15	$8,680.88	$8,246.84	$5,208.53	$13,711.88	$8,246.84	2026-05-13
36010224_1	CDM	Operating Room Services - General Classification	15	15	$8,248.00	$7,835.60	$4,948.80	$8,248.00	$7,835.60	2026-05-13
J9312	HCPCS	Injection, Rituximab, 10 Mg	15	15	$8,104.89	$7,699.65	$349.84	$8,104.89	$7,699.65	2026-05-13
J3247	HCPCS	Injection, Secukinumab, Intravenous, 1 Mg	15	15	$7,789.11	$7,399.65	$4,673.47	$7,789.11	$7,399.65	2026-05-13
1144703_1	CDM	Bigopsy Backloading Forceps	15	15	$7,779.48	$7,390.51	$4,667.69	$7,779.48	$7,390.51	2026-05-13
148511_ERX_1	CDM	Varithena Injectable Foam	15	15	$7,742.00	$7,354.90	$4,645.20	$7,742.00	$7,354.90	2026-05-13
J9177	HCPCS	Injection, Enfortumab Vedotin-ejfv, 0.25 Mg	15	15	$7,269.68	$6,906.20	$4,361.81	$7,269.68	$6,906.20	2026-05-13
J2353	HCPCS	Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg	15	15	$7,266.09	$6,902.79	$749.36	$7,266.09	$6,902.79	2026-05-13
27650	HCPCS	Repair Of Ruptured Achilles Tendon	23	15	$7,358.00	$6,990.10	$239.20	$7,358.00	$6,622.20	2026-05-13
36010222_1	CDM	Operating Room Services - General Classification	15	15	$6,920.00	$6,574.00	$4,152.00	$6,920.00	$6,574.00	2026-05-13
J9061	HCPCS	Injection, Amivantamab-vmjw, 2 Mg	15	15	$6,863.33	$6,520.16	$4,118.00	$6,863.33	$6,520.16	2026-05-13
J2506	HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	15	15	$6,836.60	$6,494.77	$4,101.96	$6,836.60	$6,494.77	2026-05-13
J1602	HCPCS	Injection, Golimumab, 1 Mg, For Intravenous Use	15	15	$6,503.37	$6,178.20	$126.38	$6,503.37	$6,178.20	2026-05-13
J0897	HCPCS	Injection, Denosumab, 1 Mg	29	15	$11,226.50	$10,665.18	$69.64	$11,226.50	$6,101.84	2026-05-13
Q5111	HCPCS	Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg	29	15	$5,532.87	$5,256.23	$1,343.81	$11,062.47	$5,532.87	2026-05-13
36010220_1	CDM	Operating Room Services - General Classification	15	15	$5,747.00	$5,459.65	$3,448.20	$5,747.00	$5,459.65	2026-05-13
37191	HCPCS	Insertion Of Vena Cava Filter With Review By Radiologist	15	15	$5,684.00	$5,399.80	$3,410.40	$5,684.00	$5,399.80	2026-05-13
J3358	HCPCS	Ustekinumab, For Intravenous Injection, 1 Mg	15	15	$5,386.18	$5,116.87	$44.85	$5,386.18	$5,116.87	2026-05-13
J0129	HCPCS	Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…	15	15	$5,221.25	$4,960.19	$140.74	$5,221.25	$4,960.19	2026-05-13
1305396_1	CDM	3.0mm Fibulock Fibular Nail Right 180mm	15	15	$4,941.75	$4,694.66	$2,965.05	$4,941.75	$4,694.66	2026-05-13
1305402_1	CDM	3.0mm Fibulock Fibular Nail Left 130mm	15	15	$4,941.75	$4,694.66	$2,965.05	$4,941.75	$4,694.66	2026-05-13
1305378_1	CDM	3.0mm Fibulock Fibular Nail Right 130mm	15	15	$4,941.75	$4,694.66	$2,965.05	$4,941.75	$4,694.66	2026-05-13
1305405_1	CDM	3.0mm Fibulock Fibular Nail Left 180mm	15	15	$4,941.75	$4,694.66	$2,965.05	$4,941.75	$4,694.66	2026-05-13
J0717	HCPCS	Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm…	15	15	$4,932.61	$4,685.98	$37.16	$4,932.61	$4,685.98	2026-05-13
1045354_1	CDM	Ventralight With Echo2 20x25cm	15	15	$4,931.10	$4,684.55	$2,958.66	$4,931.10	$4,684.55	2026-05-13
156610_1	CDM	Pin To Rod Coupling Inverted	15	15	$4,891.00	$4,646.45	$2,934.60	$4,891.00	$4,646.45	2026-05-13
J3111	HCPCS	Injection, Romosozumab-aqqg, 1 Mg	15	15	$4,762.07	$4,523.97	$2,857.24	$4,762.07	$4,523.97	2026-05-13
36010218_1	CDM	Operating Room Services - General Classification	15	15	$4,734.00	$4,497.30	$2,840.40	$4,734.00	$4,497.30	2026-05-13
338926_1	CDM	Stem Cemented Advocate 17x150	15	15	$4,719.00	$4,483.05	$2,831.40	$4,719.00	$4,483.05	2026-05-13
338925_1	CDM	Stem Cemented Advocate 16x145	15	15	$4,719.00	$4,483.05	$2,831.40	$4,719.00	$4,483.05	2026-05-13
338894_1	CDM	Stem Cemented Advocate 12x125	15	15	$4,719.00	$4,483.05	$2,831.40	$4,719.00	$4,483.05	2026-05-13
338895_1	CDM	Stem Cemented Advocate 13x130	15	15	$4,719.00	$4,483.05	$2,831.40	$4,719.00	$4,483.05	2026-05-13
338893_1	CDM	Stem Cemented Advocate 11x120 Standard	15	15	$4,719.00	$4,483.05	$2,831.40	$4,719.00	$4,483.05	2026-05-13
338924_1	CDM	Stem Cemented Advocate 15x140	15	15	$4,719.00	$4,483.05	$2,831.40	$4,719.00	$4,483.05	2026-05-13
338923_1	CDM	Stem Cemented Advocate 14x135	15	15	$4,719.00	$4,483.05	$2,831.40	$4,719.00	$4,483.05	2026-05-13
J9317	HCPCS	Injection, Sacituzumab Govitecan-hziy, 2.5 Mg	15	15	$4,511.35	$4,285.78	$2,706.81	$4,511.35	$4,285.78	2026-05-13
Q5115	HCPCS	Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg	15	15	$4,503.55	$4,278.37	$326.59	$4,503.55	$4,278.37	2026-05-13
90376	HCPCS	Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle, Heat-t…	15	15	$4,386.64	$4,167.31	$1,395.41	$4,386.64	$4,167.31	2026-05-13
J9202	HCPCS	Goserelin Acetate Implant, Per 3.6 Mg	29	15	$4,164.11	$3,955.90	$2,191.61	$11,347.54	$4,164.11	2026-05-13
59510	HCPCS	Cesarean Delivery With Care Before And After Delivery	7	7	$5,300.00	$5,035.00	$3,818.03	$4,503.84	$4,094.40	2026-05-13
21501	HCPCS	Drainage Of Deep Abscess Or Blood Accumulation In Soft Tissue Of Neck Or Chest	22	15	$4,402.00	$4,181.90	$524.25	$4,402.00	$3,961.80	2026-05-13
59610	HCPCS	Vaginal Delivery And Care Before And After Delivery After Previous Cesarean Deli…	7	7	$5,012.00	$4,761.40	$3,622.20	$4,272.84	$3,884.40	2026-05-13
1045356_1	CDM	Ventrio St Mesh Xl	15	15	$4,054.35	$3,851.63	$2,432.61	$4,054.35	$3,851.63	2026-05-13
36010216_1	CDM	Operating Room Services - General Classification	15	15	$4,021.00	$3,819.95	$2,412.60	$4,021.00	$3,819.95	2026-05-13
J7168	HCPCS	Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity	30	15	$4,056.11	$3,853.31	$2,398.01	$4,115.53	$3,796.86	2026-05-13
74174	HCPCS	CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast	15	15	$3,935.00	$3,738.25	$2,194.17	$3,935.00	$3,738.25	2026-05-13
78452	HCPCS	Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect	15	15	$3,909.00	$3,713.55	$2,345.40	$3,909.00	$3,713.55	2026-05-13
59400	HCPCS	Vaginal Delivery With Care Before And After Delivery	7	7	$4,712.00	$4,476.40	$3,442.60	$4,060.98	$3,691.80	2026-05-13
L8699	HCPCS	Prosthetic Implant, Not Otherwise Specified	15	15	$3,826.50	$3,635.18	$2,295.90	$3,826.50	$3,635.18	2026-05-13
72197	HCPCS	MRI Scan Of Pelvis Before And After Contrast	15	15	$3,796.00	$3,606.20	$2,277.60	$3,796.00	$3,606.20	2026-05-13
70471	HCPCS	Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)…	15	15	$3,781.00	$3,591.95	$2,268.60	$3,781.00	$3,591.95	2026-05-13
71552	HCPCS	MRI Scan Of Chest Before And After Contrast	15	15	$3,771.00	$3,582.45	$2,262.60	$3,771.00	$3,582.45	2026-05-13
26356	HCPCS	Primary Repair Of Finger Tendon On Underside Of The Hand Without A Graft In Zone…	15	15	$3,747.00	$3,559.65	$2,248.20	$3,747.00	$3,559.65	2026-05-13
72158	HCPCS	MRI Scan Of Lower Spinal Canal Before And After Contrast	15	15	$3,739.00	$3,552.05	$2,085.54	$3,739.00	$3,552.05	2026-05-13
43632	HCPCS	Removal Of Lower Part Of Stomach With Reattachment Of Remaining Stomach To Secon…	7	7	$4,263.00	$4,049.85	$3,320.63	$3,917.10	$3,531.33	2026-05-13
157178_1	CDM	Dvr Anatomic Extra Ext Left	15	15	$3,676.50	$3,492.68	$2,205.90	$3,676.50	$3,492.68	2026-05-13
157177_1	CDM	Dvr Anatomic Extra Ext Right	15	15	$3,676.50	$3,492.68	$2,205.90	$3,676.50	$3,492.68	2026-05-13
70543	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast	15	15	$3,654.00	$3,471.30	$2,192.40	$3,654.00	$3,471.30	2026-05-13
26990	HCPCS	Drainage Of Deep Abscess Or Blood Accumulation Of Pelvis Or Hip Near Joint	15	15	$3,646.00	$3,463.70	$2,187.60	$3,646.00	$3,463.70	2026-05-13
73223	HCPCS	MRI Scan Of Arm Joint Before And After Contrast	15	15	$3,637.00	$3,455.15	$2,182.20	$3,637.00	$3,455.15	2026-05-13
32550	HCPCS	Insertion Of Indwelling Tube For Drainage Of Lung Fluid	15	15	$3,635.00	$3,453.25	$2,181.00	$3,635.00	$3,453.25	2026-05-13
72156	HCPCS	MRI Scan Of Upper Spinal Canal Before And After Contrast	15	15	$3,626.00	$3,444.70	$2,093.90	$3,626.00	$3,444.70	2026-05-13
72157	HCPCS	MRI Scan Of Middle Spinal Canal Before And After Contrast	15	15	$3,617.00	$3,436.15	$2,099.45	$3,617.00	$3,436.15	2026-05-13
70553	HCPCS	MRI Scan Of Brain Before And After Contrast	15	15	$3,590.00	$3,410.50	$2,077.22	$3,590.00	$3,410.50	2026-05-13
24605	HCPCS	Repair Of Dislocated Elbow Under Anesthesia	22	15	$3,736.00	$3,549.20	$763.16	$3,736.00	$3,362.40	2026-05-13
74178	HCPCS	CT Scan Of Abdomen And Pelvis Before And After Contrast	15	15	$3,535.00	$3,358.25	$1,988.11	$3,535.00	$3,358.25	2026-05-13
74183	HCPCS	MRI Scan Of Abdomen Before And After Contrast	15	15	$3,512.00	$3,336.40	$2,107.20	$3,512.00	$3,336.40	2026-05-13
J3240	HCPCS	Injection, Thyrotropin Alpha, 0.9 Mg, Provided In 1.1 Mg Vial	15	15	$3,506.37	$3,331.05	$2,103.82	$5,638.80	$3,331.05	2026-05-13
Q5136	HCPCS	Injection, Denosumab-bbdz (jubbonti/wyost), Biosimilar, 1 Mg	30	15	$4,058.18	$3,855.28	$1,992.95	$4,794.78	$3,288.38	2026-05-13
73720	HCPCS	MRI Scan Of Leg Before And After Contrast	15	15	$3,456.00	$3,283.20	$2,073.60	$3,456.00	$3,283.20	2026-05-13
44150	HCPCS	Removal Of Large Bowel With Attachment Of Small Bowel To Rectum Or Creation Of O…	7	7	$4,547.00	$4,319.65	$3,030.25	$3,637.60	$3,249.60	2026-05-13
45110	HCPCS	Removal Of Rectum With Creation Of Opening From Large Bowel To Skin Through Abdo…	7	7	$4,519.00	$4,293.05	$2,972.62	$3,615.20	$3,187.80	2026-05-13
58356	HCPCS	Destruction Of Lining Of Uterus Using Ultrasound Guidance	22	15	$3,535.00	$3,358.25	$573.49	$3,535.00	$3,181.50	2026-05-13
36010214_1	CDM	Operating Room Services - General Classification	15	15	$3,334.00	$3,167.30	$2,000.40	$3,334.00	$3,167.30	2026-05-13
44207	HCPCS	Partial Removal Of Large Bowel And Reattachment To Rectum Using An Endoscope	7	7	$3,869.00	$3,675.55	$2,948.01	$3,477.54	$3,135.06	2026-05-13
73220	HCPCS	MRI Scan Of Arm Before And After Contrast	15	15	$3,206.00	$3,045.70	$1,923.60	$3,206.00	$3,045.70	2026-05-13
Q5158	HCPCS	Injection, Denosumab-bnht (bomyntra/conexxence), Biosimilar, 1 Mg	30	15	$3,533.28	$3,356.61	$1,845.84	$3,990.16	$3,045.64	2026-05-13
70549	HCPCS	MRI Scan Of Blood Vessels Of Neck Before And After Contrast	15	15	$3,172.00	$3,013.40	$1,903.20	$3,252.23	$3,013.40	2026-05-13
J7165	HCPCS	Injection, Prothrombin Complex Concentrate, Human-lans, Per I.u. Of Factor Ix Ac…	15	15	$3,168.37	$3,009.95	$1,901.02	$3,168.37	$3,009.95	2026-05-13
26951	HCPCS	Amputation Of Finger Or Thumb With Direct Closure	22	15	$3,342.00	$3,174.90	$1,071.44	$3,342.00	$3,007.80	2026-05-13
155855_1	CDM	Tvt Obturator System Gynecare	15	15	$3,159.39	$3,001.42	$1,895.63	$3,159.39	$3,001.42	2026-05-13
Q5157	HCPCS	Injection, Denosumab-bmwo (stoboclo/osenvelt), Biosimilar, 1 Mg	30	15	$3,747.79	$3,560.40	$1,808.71	$4,481.06	$2,984.36	2026-05-13
74177	HCPCS	CT Scan Of Abdomen And Pelvis With Contrast	15	15	$3,135.00	$2,978.25	$1,731.95	$3,135.00	$2,978.25	2026-05-13
J7296	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System, (kyleena), 19.5 Mg	15	15	$3,117.76	$2,961.87	$1,870.66	$3,510.90	$2,961.87	2026-05-13
49446	HCPCS	Conversion Of Stomach Tube To Stomach-to-small Bowel Tube Using Fluoroscopic Gui…	15	15	$3,116.00	$2,960.20	$1,427.39	$3,116.00	$2,960.20	2026-05-13
1045355_1	CDM	Ventralight With Echo2 15x20 Cm	15	15	$3,104.10	$2,948.90	$1,862.46	$3,104.10	$2,948.90	2026-05-13
58558	HCPCS	Biopsy Of Lining Of Uterus And/or Removal Of Polyp Using An Endoscope	22	15	$3,275.00	$3,111.25	$377.10	$3,275.00	$2,947.50	2026-05-13
57522	HCPCS	Removal Or Destruction Of Cervix Using Loop Electrode	22	15	$3,275.00	$3,111.25	$403.40	$3,275.00	$2,947.50	2026-05-13
73723	HCPCS	MRI Scan Of Leg Joint Before And After Contrast	15	15	$3,080.00	$2,926.00	$1,848.00	$3,080.00	$2,926.00	2026-05-13
27132	HCPCS	Total Hip Replacement After Previous Hip Surgery	7	7	$3,816.00	$3,625.20	$2,710.78	$3,197.70	$2,907.00	2026-05-13
72147	HCPCS	MRI Scan Of Middle Spinal Canal With Contrast	15	15	$3,058.00	$2,905.10	$1,834.80	$3,058.00	$2,905.10	2026-05-13
44143	HCPCS	Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin	7	7	$4,040.00	$3,838.00	$2,708.54	$3,232.00	$2,904.60	2026-05-13
44227	HCPCS	Closure Of Opening From Large Or Small Bowel To Skin Using An Endoscope	7	7	$3,916.00	$3,720.20	$2,707.98	$3,194.40	$2,904.00	2026-05-13
70546	HCPCS	MRI Scan Of Blood Vessels Of Head Before And After Contrast	15	15	$3,043.00	$2,890.85	$1,825.80	$3,229.95	$2,890.85	2026-05-13
78451	HCPCS	Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect	15	15	$3,036.00	$2,884.20	$1,821.60	$3,036.00	$2,884.20	2026-05-13
44145	HCPCS	Partial Removal Of Large Bowel And Reattachment To Rectum	7	7	$4,099.00	$3,894.05	$2,688.96	$3,279.20	$2,883.60	2026-05-13
73219	HCPCS	MRI Scan Of Arm With Contrast	15	15	$3,026.00	$2,874.70	$1,815.60	$3,026.00	$2,874.70	2026-05-13
1045357_1	CDM	Ventrio St Mesh Large	15	15	$3,003.15	$2,852.99	$1,801.89	$3,003.15	$2,852.99	2026-05-13
J2802	HCPCS	Injection, Romiplostim, 1 Microgram	30	15	$3,069.51	$2,916.03	$1,796.71	$3,144.51	$2,844.78	2026-05-13
J1950	HCPCS	Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg	29	15	$4,739.40	$4,502.43	$77.28	$4,739.40	$2,843.64	2026-05-13
26550	HCPCS	Surgical Creation Of Thumb	7	7	$3,238.00	$3,076.10	$2,590.40	$3,130.38	$2,822.09	2026-05-13
J9035	HCPCS	Injection, Bevacizumab, 10 Mg	29	15	$2,814.70	$2,673.97	$289.54	$11,258.71	$2,814.70	2026-05-13
95811	HCPCS	Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)	15	15	$2,961.00	$2,812.95	$1,776.60	$3,526.56	$2,812.95	2026-05-13
70542	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast	15	15	$2,950.00	$2,802.50	$1,770.00	$2,950.00	$2,802.50	2026-05-13
49406	HCPCS	Drainage Of Fluid Collection Of Abdominal Cavity By Tube Using Imaging Guidance	15	15	$2,942.00	$2,794.90	$1,348.03	$2,942.00	$2,794.90	2026-05-13
44626	HCPCS	Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An…	7	7	$3,899.00	$3,704.05	$2,603.35	$3,119.20	$2,791.80	2026-05-13
49020	HCPCS	Drainage Of Abdominal Abscess Or Infection	7	7	$3,583.00	$3,403.85	$2,593.84	$3,059.76	$2,781.60	2026-05-13
J3101	HCPCS	Injection, Tenecteplase, 1 Mg	15	15	$2,924.74	$2,778.50	$452.81	$2,924.74	$2,778.50	2026-05-13
75635	HCPCS	CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast	15	15	$2,883.00	$2,738.85	$1,729.80	$2,883.00	$2,738.85	2026-05-13
72196	HCPCS	MRI Scan Of Pelvis With Contrast	15	15	$2,869.00	$2,725.55	$1,721.40	$2,869.00	$2,725.55	2026-05-13
J0841	HCPCS	Injection, Crotalidae Immune F(ab')2 (equine), 120 Mg	15	15	$2,865.85	$2,722.56	$1,719.51	$4,712.25	$2,722.56	2026-05-13
Q5118	HCPCS	Injection, Bevacizumab-bvzr, Biosimilar, (zirabev), 10 Mg	30	15	$3,936.07	$3,739.26	$1,036.82	$6,144.11	$2,707.25	2026-05-13
44661	HCPCS	Closure Of Abnormal Drainage Tract From Small Bowel To Urinary Bladder With Rese…	7	7	$3,775.00	$3,586.25	$2,521.67	$3,020.00	$2,704.20	2026-05-13
157170_1	CDM	Dvr Anatomic Standard Left	15	15	$2,835.00	$2,693.25	$1,701.00	$2,835.00	$2,693.25	2026-05-13
157172_1	CDM	Dvr Anatomic Short Left	15	15	$2,835.00	$2,693.25	$1,701.00	$2,835.00	$2,693.25	2026-05-13
44204	HCPCS	Partial Removal Of Large Bowel Using An Endoscope	8	7	$3,358.00	$3,190.10	$537.60	$2,950.20	$2,670.82	2026-05-13
23030	HCPCS	Drainage Of Deep Abscess Or Blood Accumulation Of Shoulder	22	15	$2,948.00	$2,800.60	$401.72	$2,948.00	$2,653.20	2026-05-13
27301	HCPCS	Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee	22	15	$2,948.00	$2,800.60	$814.07	$2,948.00	$2,653.20	2026-05-13
20680	HCPCS	Removal Of Deep Implant From Bone	23	15	$2,948.00	$2,800.60	$152.00	$2,948.00	$2,653.20	2026-05-13
10180	HCPCS	Complex Drainage Of Wound Infection After Surgery	22	15	$2,948.00	$2,800.60	$285.90	$2,948.00	$2,653.20	2026-05-13
J0881	HCPCS	Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use)	15	15	$2,780.00	$2,641.00	$28.20	$2,780.00	$2,641.00	2026-05-13
J9395	HCPCS	Injection, Fulvestrant, 25 Mg	15	15	$2,773.54	$2,634.86	$361.05	$2,773.54	$2,634.86	2026-05-13
81164	HCPCS	Gene Analysis (breast Cancer 1 And 2) For Duplication Or Deletion Variants	15	15	$2,765.00	$2,626.75	$1,659.00	$3,388.52	$2,626.75	2026-05-13
15734	HCPCS	Creation Of Muscle Graft To Trunk	7	7	$3,340.00	$3,173.00	$2,439.98	$2,878.26	$2,616.60	2026-05-13
156647_1	CDM	Plt Insert Cross-linked	15	15	$2,733.75	$2,597.06	$1,640.25	$2,733.75	$2,597.06	2026-05-13
19081	HCPCS	Biopsy Of Breast And Placement Of Locating Device Using X-ray With Needle, First…	15	15	$2,718.00	$2,582.10	$1,348.03	$2,718.00	$2,582.10	2026-05-13
72194	HCPCS	CT Scan Of Pelvis Before And After Contrast	15	15	$2,715.00	$2,579.25	$1,564.84	$2,715.00	$2,579.25	2026-05-13
156124_1	CDM	Stem Cemented Versys 16x145	15	15	$2,715.00	$2,579.25	$1,629.00	$2,715.00	$2,579.25	2026-05-13
75010099_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,708.00	$2,572.60	$1,624.80	$2,708.00	$2,572.60	2026-05-13
95810	HCPCS	Sleep Study In Sleep Lab (6 Years Or Older)	15	15	$2,703.00	$2,567.85	$1,621.80	$3,350.72	$2,567.85	2026-05-13
J7307	HCPCS	Etonogestrel (contraceptive) Implant System, Including Implant And Supplies	29	15	$2,567.00	$2,438.65	$1,540.20	$3,275.03	$2,567.00	2026-05-13
J1439	HCPCS	Injection, Ferric Carboxymaltose, 1 Mg	15	15	$2,694.11	$2,559.40	$4.95	$2,694.11	$2,559.40	2026-05-13
27137	HCPCS	Revision Of Hip Socket Part Of Hip Prosthesis	7	7	$3,355.00	$3,187.25	$2,381.79	$2,809.62	$2,554.20	2026-05-13
43631	HCPCS	Removal Of Lower Part Of Stomach With Reattachment Of Remaining Stomach To First…	7	7	$3,512.00	$3,336.40	$2,366.69	$2,809.60	$2,538.00	2026-05-13
74182	HCPCS	MRI Scan Of Abdomen With Contrast	15	15	$2,657.00	$2,524.15	$1,594.20	$2,657.00	$2,524.15	2026-05-13
23472	HCPCS	Prosthetic Repair Of Shoulder Joint, Total Shoulder	7	7	$3,564.00	$3,385.80	$2,348.78	$2,851.20	$2,518.80	2026-05-13
J7301	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System (skyla), 13.5 Mg	29	15	$2,596.06	$2,466.26	$1,557.64	$2,923.43	$2,502.00	2026-05-13
71275	HCPCS	CT Scan Of Blood Vessels Of Chest With Contrast	15	15	$2,623.00	$2,491.85	$1,573.80	$2,623.00	$2,491.85	2026-05-13
480494_1	CDM	Speedbridge Implant System With Biocomp Swvlck- 5584012	15	15	$2,610.00	$2,479.50	$1,566.00	$2,610.00	$2,479.50	2026-05-13
26952	HCPCS	Amputation Of Finger Or Thumb With Tissue Flap	22	15	$2,754.00	$2,616.30	$1,058.01	$2,754.00	$2,478.60	2026-05-13
72142	HCPCS	MRI Scan Of Upper Spinal Canal With Contrast	15	15	$2,606.00	$2,475.70	$1,563.60	$2,606.00	$2,475.70	2026-05-13
44602	HCPCS	Suture Of Tear Of Hole In Small Bowel	7	7	$3,480.00	$3,306.00	$2,298.99	$2,784.00	$2,465.40	2026-05-13
74175	HCPCS	CT Scan Of Blood Vessels Of Abdomen With Contrast	15	15	$2,572.00	$2,443.40	$1,543.20	$2,572.00	$2,443.40	2026-05-13
44640	HCPCS	Closure Of Abnormal Drainage Tract From Small Bowel To Skin	7	7	$3,054.00	$2,901.30	$2,276.61	$2,685.54	$2,441.40	2026-05-13
27486	HCPCS	Revision Of Component Of Total Knee Joint Prosthesis	7	7	$3,199.00	$3,039.05	$2,276.05	$2,684.88	$2,440.80	2026-05-13
70552	HCPCS	MRI Scan Of Brain With Contrast	15	15	$2,549.00	$2,421.55	$1,529.40	$2,549.00	$2,421.55	2026-05-13
44202	HCPCS	Partial Removal And Reconnection Of Small Bowel Using An Endoscope	7	7	$3,010.00	$2,859.50	$2,257.02	$2,662.44	$2,408.00	2026-05-13
70545	HCPCS	MRI Scan Of Blood Vessels Of Head With Contrast	15	15	$2,527.00	$2,400.65	$1,516.20	$2,527.00	$2,400.65	2026-05-13
70498	HCPCS	CT Scan Of Blood Vessels Of Neck With Contrast	15	15	$2,521.00	$2,394.95	$1,512.60	$2,521.00	$2,394.95	2026-05-13
156125_1	CDM	Stem Cemented Versys 12x125	15	15	$2,520.00	$2,394.00	$1,512.00	$2,520.00	$2,394.00	2026-05-13
49405	HCPCS	Drainage Of Fluid Collection By Tube Through Skin Using Imaging Guidance	15	15	$2,515.00	$2,389.25	$1,348.03	$2,515.00	$2,389.25	2026-05-13
43840	HCPCS	Suture Of Perforated Ulcer, Wound, Or Injury Of Stomach Or Upper Small Bowel	7	7	$2,963.00	$2,814.85	$2,219.54	$2,618.22	$2,370.40	2026-05-13
72149	HCPCS	MRI Scan Of Lower Spinal Canal With Contrast	15	15	$2,493.00	$2,368.35	$1,495.80	$2,493.00	$2,368.35	2026-05-13
70548	HCPCS	MRI Scan Of Blood Vessels Of Neck With Contrast	15	15	$2,483.00	$2,358.85	$1,489.80	$2,483.00	$2,358.85	2026-05-13
74176	HCPCS	CT Scan Of Abdomen And Pelvis Without Contrast	15	15	$2,470.00	$2,346.50	$891.01	$2,470.00	$2,346.50	2026-05-13
27130	HCPCS	Replacement Of Thigh Bone And Hip Joint With Prosthesis	8	7	$3,086.00	$2,931.70	$494.40	$2,587.86	$2,342.80	2026-05-13
1211160_1	CDM	Long Nail Kit R1/5 Ti Left 11x400mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211134_1	CDM	Long Nail Kit R1/5 Ti Right 11x380mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211107_1	CDM	Long Nail Kit R1/5 Ti Right 11x320mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211150_1	CDM	Long Nail Kit R1/5 Ti Left 11x340mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211126_1	CDM	Long Nail Kit R1/5 Ti Right 11x360mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211136_1	CDM	Long Nail Kit R1/5 Ti Right 11x400mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211155_1	CDM	Long Nail Kit R1/5 Ti Left 11x380mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211123_1	CDM	Long Nail Kit R1/5 Ti Right 11x340mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211162_1	CDM	Long Nail Kit R1/5 Ti Left 11x420mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211139_1	CDM	Long Nail Kit R1/5 Ti Right 11x420mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211144_1	CDM	Long Nail Kit R1/5 Ti Left 11x320mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
1211153_1	CDM	Long Nail Kit R1/5 Ti Left 11x360mmx125	15	15	$2,465.63	$2,342.35	$1,479.38	$2,465.63	$2,342.35	2026-05-13
27552	HCPCS	Closed Treatment Of Dislocated Knee Under Anesthesia	23	15	$2,602.00	$2,471.90	$226.40	$2,602.00	$2,341.80	2026-05-13
27447	HCPCS	Replacement Of Knee Joint, Both Sides Of Knee	8	7	$3,085.00	$2,930.75	$494.40	$2,584.56	$2,339.81	2026-05-13
50432	HCPCS	Placement Of Tube Of Kidney Using Imaging Guidance With Review By Radiologist	15	15	$2,461.00	$2,337.95	$1,476.60	$2,461.00	$2,337.95	2026-05-13
44140	HCPCS	Partial Removal Of Large Bowel With Connection	8	7	$3,018.00	$2,867.10	$482.40	$2,578.62	$2,334.43	2026-05-13
J0630	HCPCS	Injection, Calcitonin Salmon, Up To 400 Units	15	15	$2,454.91	$2,332.16	$1,472.95	$8,446.65	$2,332.16	2026-05-13
478529_1	CDM	Obtryx Ii Transobturator	15	15	$2,448.60	$2,326.17	$1,469.16	$2,448.60	$2,326.17	2026-05-13
478571_1	CDM	Obtryx Ii Obturator	15	15	$2,448.60	$2,326.17	$1,469.16	$2,448.60	$2,326.17	2026-05-13
J9179	HCPCS	Injection, Eribulin Mesylate, 0.1 Mg	15	15	$2,432.72	$2,311.08	$409.24	$2,432.72	$2,311.08	2026-05-13
72191	HCPCS	CT Scan Of Blood Vessels Of Pelvis With Contrast	15	15	$2,427.00	$2,305.65	$1,456.20	$2,427.00	$2,305.65	2026-05-13
90378	HCPCS	Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle	15	15	$2,406.00	$2,285.70	$1,443.60	$5,324.51	$2,285.70	2026-05-13
44130	HCPCS	Creation Of Connection Between 2 Segments Of Small Bowel	8	7	$2,864.00	$2,720.80	$459.20	$2,526.48	$2,284.43	2026-05-13
J7297	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System (liletta), 52 Mg	15	15	$2,399.00	$2,279.05	$1,439.40	$2,643.41	$2,279.05	2026-05-13
58554	HCPCS	Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, More…	8	7	$2,981.00	$2,831.95	$476.80	$2,516.58	$2,278.27	2026-05-13
J7327	HCPCS	Hyaluronan Or Derivative, Monovisc, For Intra-articular Injection, Per Dose	29	15	$2,384.87	$2,265.63	$1,430.76	$3,162.08	$2,265.37	2026-05-13
49618	HCPCS	Repair Of Recurrent Entrapped Hernia Of Abdomen, More Than 10 Cm In Length	7	7	$2,665.00	$2,531.75	$2,132.00	$2,531.75	$2,265.25	2026-05-13
73722	HCPCS	MRI Scan Of Leg Joint With Contrast	15	15	$2,379.00	$2,260.05	$1,427.40	$2,379.00	$2,260.05	2026-05-13
J0882	HCPCS	Injection, Darbepoetin Alfa, 1 Microgram (for Esrd On Dialysis)	71	15	$2,458.71	$2,335.77	$28.20	$6,146.77	$2,249.72	2026-05-13
47531	HCPCS	Injection Of Bile Duct For X-ray Through Already Existing Skin Access Using Imag…	15	15	$2,365.00	$2,246.75	$1,419.00	$2,911.16	$2,246.75	2026-05-13
74170	HCPCS	CT Scan Of Abdomen Before And After Contrast	15	15	$2,363.00	$2,244.85	$1,417.80	$2,363.00	$2,244.85	2026-05-13
72133	HCPCS	CT Scan Of Lower Spine Before And After Contrast	15	15	$2,355.00	$2,237.25	$1,413.00	$2,355.00	$2,237.25	2026-05-13
70496	HCPCS	CT Scan Of Blood Vessels Of Head With Contrast	15	15	$2,353.00	$2,235.35	$1,411.80	$2,353.00	$2,235.35	2026-05-13
65800	HCPCS	Removal Of Eye Fluid	15	15	$2,349.00	$2,231.55	$1,409.40	$2,349.00	$2,231.55	2026-05-13
70492	HCPCS	CT Scan Of Soft Tissue Of Neck Before And After Contrast	15	15	$2,341.00	$2,223.95	$1,286.40	$2,341.00	$2,223.95	2026-05-13
72195	HCPCS	MRI Scan Of Pelvis Without Contrast	15	15	$2,334.00	$2,217.30	$1,400.40	$2,334.00	$2,217.30	2026-05-13
59515	HCPCS	Cesarean Delivery With Care After Delivery	7	7	$2,873.00	$2,729.35	$2,064.00	$2,434.74	$2,213.40	2026-05-13
1201142_1	CDM	49 Mm Distal Radius Plate Lt Intermediate	15	15	$2,326.95	$2,210.60	$1,396.17	$2,326.95	$2,210.60	2026-05-13
75010021_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
75010015_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
75010020_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
36010413_1	CDM	Operating Room Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
75010211_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
75010016_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
75010101_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
75010185_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
75010098_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
75010102_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,324.00	$2,207.80	$1,394.40	$2,324.00	$2,207.80	2026-05-13
47610	HCPCS	Removal Of Gallbladder With Exploration Of Common Bile Duct	7	7	$3,028.00	$2,876.60	$2,048.89	$2,422.40	$2,197.20	2026-05-13
27429	HCPCS	Reconstruction Of Ligaments Inside And Outside Knee Joint	8	7	$2,829.00	$2,687.55	$453.60	$2,390.52	$2,164.14	2026-05-13
54600	HCPCS	Repair Of Twisted Testicle	22	15	$2,404.00	$2,283.80	$731.27	$2,696.76	$2,163.60	2026-05-13
44160	HCPCS	Partial Removal Of Small And Large Bowel With Attachment Of Small And Large Bowe…	8	7	$3,013.00	$2,862.35	$481.60	$2,410.40	$2,159.36	2026-05-13
70547	HCPCS	MRI Scan Of Blood Vessels Of Neck Without Contrast	15	15	$2,273.00	$2,159.35	$1,363.80	$2,273.00	$2,159.35	2026-05-13
J7298	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg	29	15	$2,193.52	$2,083.84	$1,316.11	$3,510.90	$2,159.10	2026-05-13
J9264	HCPCS	Injection, Paclitaxel Protein-bound Particles, 1 Mg	15	15	$2,270.68	$2,157.15	$49.43	$2,270.68	$2,157.15	2026-05-13
71550	HCPCS	MRI Scan Of Chest Without Contrast	15	15	$2,266.00	$2,152.70	$1,359.60	$2,695.34	$2,152.70	2026-05-13
72146	HCPCS	MRI Scan Of Middle Spinal Canal Without Contrast	15	15	$2,266.00	$2,152.70	$1,186.17	$2,266.00	$2,152.70	2026-05-13
156650_1	CDM	Plate Wrist Fusion 8hl/standard	15	15	$2,248.95	$2,136.50	$1,349.37	$2,248.95	$2,136.50	2026-05-13
73202	HCPCS	CT Scan Of Arm Before And After Contrast	15	15	$2,243.00	$2,130.85	$1,345.80	$2,243.00	$2,130.85	2026-05-13
156612_1	CDM	Rod To Rod Coupling Multiplanar	15	15	$2,241.84	$2,129.75	$1,345.10	$2,241.84	$2,129.75	2026-05-13
70336	HCPCS	MRI Scan Of Jaw Joint	15	15	$2,241.00	$2,128.95	$1,344.60	$2,241.00	$2,128.95	2026-05-13
44120	HCPCS	Partial Removal Of Small Bowel With Reconnection	8	7	$2,964.00	$2,815.80	$473.60	$2,371.20	$2,128.89	2026-05-13
27244	HCPCS	Treatment Of Broken Neck Of Thigh Bone With Plate/screw Implant	8	7	$2,803.00	$2,662.85	$448.80	$2,345.64	$2,123.52	2026-05-13
70482	HCPCS	CT Scan Of Cranial Cavity Before And After Contrast	15	15	$2,231.00	$2,119.45	$1,338.60	$2,231.00	$2,119.45	2026-05-13
73222	HCPCS	MRI Scan Of Arm Joint With Contrast	15	15	$2,228.00	$2,116.60	$1,336.80	$2,347.31	$2,116.60	2026-05-13
70544	HCPCS	MRI Scan Of Blood Vessels Of Head Without Contrast	15	15	$2,221.00	$2,109.95	$1,332.60	$2,221.00	$2,109.95	2026-05-13
81163	HCPCS	Gene Analysis (breast Cancer 1 And 2) Of Full Sequence	15	15	$2,221.00	$2,109.95	$1,332.60	$2,714.40	$2,109.95	2026-05-13
72126	HCPCS	CT Scan Of Upper Spine With Contrast	15	15	$2,221.00	$2,109.95	$1,311.48	$2,221.00	$2,109.95	2026-05-13
72141	HCPCS	MRI Scan Of Upper Spinal Canal Without Contrast	15	15	$2,221.00	$2,109.95	$1,183.42	$2,221.00	$2,109.95	2026-05-13
51102	HCPCS	Aspiration Of Bladder With Insertion Of Bladder Tube To Skin	22	15	$2,335.00	$2,218.25	$234.99	$2,335.00	$2,101.50	2026-05-13
75010108_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,210.00	$2,099.50	$1,326.00	$2,210.00	$2,099.50	2026-05-13
75010024_1	CDM	Gastro - Intestinal (gi) Services - General Classification	15	15	$2,210.00	$2,099.50	$1,326.00	$2,210.00	$2,099.50	2026-05-13
19307	HCPCS	Removal Of Breast And Underarm Lymph Nodes	7	7	$2,878.00	$2,734.10	$1,957.13	$2,308.68	$2,098.80	2026-05-13
70470	HCPCS	CT Scan Of Head Or Brain Before And After Contrast	15	15	$2,209.00	$2,098.55	$1,005.20	$2,209.00	$2,098.55	2026-05-13
70540	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast	15	15	$2,208.00	$2,097.60	$1,324.80	$2,208.00	$2,097.60	2026-05-13
47490	HCPCS	Insertion Of Tube Into Gallbladder Using Imaging Guidance With Review By Radiolo…	15	15	$2,207.00	$2,096.65	$1,324.20	$2,911.16	$2,096.65	2026-05-13
72148	HCPCS	MRI Scan Of Lower Spinal Canal Without Contrast	15	15	$2,207.00	$2,096.65	$1,183.42	$2,207.00	$2,096.65	2026-05-13
44320	HCPCS	Creation Of Opening From Large Bowel To Skin	7	7	$2,921.00	$2,774.95	$1,953.21	$2,336.80	$2,094.60	2026-05-13
58573	HCPCS	Removal Of Uterus, Tubes, And/or Ovaries Through Abdomen Using An Endoscope, Mor…	7	7	$2,317.00	$2,201.15	$1,853.60	$2,311.98	$2,084.29	2026-05-13
74181	HCPCS	MRI Scan Of Abdomen Without Contrast	15	15	$2,193.00	$2,083.35	$1,315.80	$2,193.00	$2,083.35	2026-05-13
23470	HCPCS	Partial Replacement Of Shoulder Joint	7	7	$2,941.00	$2,793.95	$1,942.58	$2,352.80	$2,083.20	2026-05-13
72210004_1	CDM	Labor Room/delivery - Delivery Room	15	15	$2,190.00	$2,080.50	$1,314.00	$2,190.00	$2,080.50	2026-05-13
73719	HCPCS	MRI Scan Of Leg With Contrast	15	15	$2,190.00	$2,080.50	$1,314.00	$2,190.00	$2,080.50	2026-05-13
35840	HCPCS	Exploration Of Abdomen For Bleeding, Blood Clot, Or Infection After Surgery	8	7	$2,603.00	$2,472.85	$416.00	$2,300.76	$2,078.28	2026-05-13
49423	HCPCS	Exchange Of Abdominal Cavity Drainage Tube Using Imaging Guidance	15	15	$2,183.00	$2,073.85	$1,309.80	$2,183.00	$2,073.85	2026-05-13
73706	HCPCS	CT Scan Of Blood Vessels Of Lower Leg With Contrast	15	15	$2,175.00	$2,066.25	$1,305.00	$2,175.00	$2,066.25	2026-05-13
J0585	HCPCS	Injection, Onabotulinumtoxina, 1 Unit	29	15	$2,133.31	$2,026.64	$22.16	$2,293.05	$2,063.75	2026-05-13
27236	HCPCS	Treatment Of Upper End Of Broken Thigh Bone With Placement Of Stabilizing Device…	8	7	$2,684.00	$2,549.80	$428.80	$2,278.98	$2,063.17	2026-05-13
J9280	HCPCS	Injection, Mitomycin, 5 Mg	15	15	$2,168.81	$2,060.37	$382.24	$2,168.81	$2,060.37	2026-05-13
1045352_1	CDM	Ventrio St Mesh Medium	15	15	$2,166.00	$2,057.70	$1,299.60	$2,166.00	$2,057.70	2026-05-13
44125	HCPCS	Partial Removal Of Small Bowel With Creation Of Opening To Skin	7	7	$2,569.00	$2,440.55	$1,920.76	$2,265.78	$2,055.20	2026-05-13
27536	HCPCS	Treatment Of Broken Shin Bone On Both Sides Of Upper End	7	7	$2,509.00	$2,383.55	$1,921.32	$2,266.44	$2,043.23	2026-05-13
20696	HCPCS	Placement Of Multiple Direction External Bone Stabilizing Device To Arm Or Leg U…	7	7	$2,456.00	$2,333.20	$1,920.76	$2,265.78	$2,042.64	2026-05-13
Q5126	HCPCS	Injection, Bevacizumab-maly, Biosimilar, (alymsys), 10 Mg	30	15	$2,941.55	$2,794.48	$818.93	$4,518.22	$2,037.90	2026-05-13
38101	HCPCS	Partial Removal Of Spleen	7	7	$2,791.00	$2,651.45	$1,900.06	$2,241.36	$2,037.60	2026-05-13
156126_1	CDM	Stem Cemented Versys 11x120	15	15	$2,137.32	$2,030.45	$1,282.39	$2,137.32	$2,030.45	2026-05-13
73206	HCPCS	CT Scan Of Blood Vessels Of Arm With Contrast	15	15	$2,136.00	$2,029.20	$1,281.60	$2,136.00	$2,029.20	2026-05-13
73718	HCPCS	MRI Scan Of Leg Without Contrast	15	15	$2,119.00	$2,013.05	$1,271.40	$2,119.00	$2,013.05	2026-05-13
27218	HCPCS	Treatment Of Broken And/or Dislocated Back Of Pelvis	7	7	$2,730.00	$2,593.50	$1,872.65	$2,209.02	$2,008.20	2026-05-13
27446	HCPCS	Replacement Of Knee Joint On Side Of Knee	7	7	$2,510.00	$2,384.50	$1,873.77	$2,210.34	$2,008.00	2026-05-13
58290	HCPCS	Removal Of Uterus Through Vagina, More Than 250.0 G	7	7	$2,573.00	$2,444.35	$1,872.09	$2,208.36	$2,007.60	2026-05-13
38100	HCPCS	Removal Of Spleen	8	7	$2,643.00	$2,510.85	$422.40	$2,216.94	$2,007.01	2026-05-13
Q0249	HCPCS	Injection, Tocilizumab, For Hospitalized Adults And Pediatric Patients (2 Years …	45	15	$2,111.25	$2,005.69	$1,166.89	$8,643.71	$2,005.69	2026-05-13
50435	HCPCS	Replacement Of Kidney Drainage Tube Using Imaging Guidance With Review By Radiol…	15	15	$2,110.00	$2,004.50	$1,266.00	$2,110.00	$2,004.50	2026-05-13
157062_1	CDM	Hydroset 5cc Injectable Bone Substitute	15	15	$2,107.50	$2,002.13	$1,264.50	$2,107.50	$2,002.13	2026-05-13
1225645_1	CDM	Locking Compression Plate 5.0mm Narrow 14 Hole L259mm	15	15	$2,104.32	$1,999.10	$1,262.59	$2,104.32	$1,999.10	2026-05-13
1225652_1	CDM	Locking Compression Plate 5.0mm Broad 13 Hole L245mm	15	15	$2,104.32	$1,999.10	$1,262.59	$2,104.32	$1,999.10	2026-05-13
1225653_1	CDM	Locking Compression Plate 5.0mm Broad 14 Hole L263mm	15	15	$2,104.32	$1,999.10	$1,262.59	$2,104.32	$1,999.10	2026-05-13
J9145	HCPCS	Injection, Daratumumab, 10 Mg	29	15	$1,998.23	$1,898.32	$189.86	$5,661.58	$1,998.23	2026-05-13
74160	HCPCS	CT Scan Of Abdomen With Contrast	15	15	$2,096.00	$1,991.20	$1,257.60	$2,096.00	$1,991.20	2026-05-13
71270	HCPCS	CT Scan Of Chest Before And After Contrast	15	15	$2,096.00	$1,991.20	$1,257.60	$2,096.00	$1,991.20	2026-05-13
73721	HCPCS	MRI Scan Of Leg Joint Without Contrast	15	15	$2,073.00	$1,969.35	$1,243.80	$2,073.00	$1,969.35	2026-05-13
47605	HCPCS	Removal Of Gallbladder With X-ray Study Of Bile Ducts	7	7	$2,719.00	$2,583.05	$1,835.16	$2,175.20	$1,968.00	2026-05-13
28192	HCPCS	Removal Of Foreign Body Of Foot Tissue, Deep	22	15	$2,186.00	$2,076.70	$504.11	$2,186.00	$1,967.40	2026-05-13
26418	HCPCS	Repair Of Tendon On Top Side Of Finger	22	15	$2,183.00	$2,073.85	$952.83	$2,183.00	$1,964.70	2026-05-13
62327	HCPCS	Insertion Of Tube And Injection Of Substance Into Lower Spine Canal Using Imagin…	15	15	$2,068.00	$1,964.60	$672.18	$2,068.00	$1,964.60	2026-05-13
27125	HCPCS	Partial Replacement Of Thigh Bone At Hip Joint With Prosthesis	8	7	$2,580.00	$2,451.00	$413.60	$2,159.52	$1,955.02	2026-05-13
58553	HCPCS	Removal Of Uterus Through Vagina Using An Endoscope, More Than 250.0	8	7	$2,542.00	$2,414.90	$407.20	$2,158.20	$1,953.83	2026-05-13
1225247_1	CDM	Locking Compression Plate 5.0mm Narrow 9 Hole L169mm	15	15	$2,056.34	$1,953.52	$1,233.80	$2,056.34	$1,953.52	2026-05-13
1225647_1	CDM	Locking Compression Plate 5.0mm Broad 8 Hole L155mm	15	15	$2,056.34	$1,953.52	$1,233.80	$2,056.34	$1,953.52	2026-05-13
1225648_1	CDM	Locking Compression Plate 5.0mm Broad 9 Hole L173mm	15	15	$2,056.34	$1,953.52	$1,233.80	$2,056.34	$1,953.52	2026-05-13
1225651_1	CDM	Locking Compression Plate 5.0mm Broad 12 Hole L227mm	15	15	$2,056.34	$1,953.52	$1,233.80	$2,056.34	$1,953.52	2026-05-13
1225649_1	CDM	Locking Compression Plate 5.0mm Broad 10 Hole L191mm	15	15	$2,056.34	$1,953.52	$1,233.80	$2,056.34	$1,953.52	2026-05-13
1225643_1	CDM	Locking Compression Plate 5.0mm Narrow 12 Hole L223mm	15	15	$2,056.34	$1,953.52	$1,233.80	$2,056.34	$1,953.52	2026-05-13
1225642_1	CDM	Locking Compression Plate 5.0mm Narrow 10 Hole L187mm	15	15	$2,056.34	$1,953.52	$1,233.80	$2,056.34	$1,953.52	2026-05-13

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